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Extra- and intradural spinal metastases from breast cancer

Case contributed by Roberto Schubert
Diagnosis almost certain

Presentation

Aggravating low back pain, flaccid paresis and hypoesthesia of both legs, and urinary retention.

Patient Data

Age: 60 years
Gender: Female

Multiple nodules along the cauda equina, a large inhomogeneous lesion of the conus medullaris, and a bone metastasis invading the sacral canal.

After Gd administration, the intradural lesions show marked enhancement. The sacral metastasis enhances only moderately.

Case Discussion

MRI of the lumbar spine a 60-year-old woman with advanced breast cancer and known skeletal metastases showed secondary neoplastic lesions in multiple locations:

  • bone metastasis of the os sacrum invading the sacral canal (extradural)
  • large metastasis of the conus medullaris (intradural-intramedullary)
  • multiple nodular metastases of the cauda equina (intradural-leptomeningeal)

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